Summary for Clinicians: Clinical Practice Guidelines for Outpatient Respiratory Management of Infants, Children, and Adolescents with Post-Prematurity Respiratory Disease
Pulmonary disease is a common sequela of premature birth. Bronchopulmonary dysplasia (BPD) (1), also known as chronic lung disease of prematurity, afflicts 12,000–15,000 infants in the United States per year (2–5) and 50% of infants with birth weights less than 1,000 g (6). Premature infants with respiratory disease have prolonged and recurrent hospitalizations (7) with a continued need for close clinical monitoring in outpatient settings.
In 2003, the American Thoracic Society published the “Statement on the Care of the Child with Chronic Lung Disease of Infancy and Childhood,” which has been a valuable clinical tool. Given significant advances in the care of extremely premature infants and subsequent changing physiology of chronic lung disease of infancy (8), there was a need for updated longitudinal recommendations for infants, children, and adolescents who were born premature and have chronic lung disease.
The American Thoracic Society convened a multidisciplinary panel of international specialists with expertise in post-prematurity respiratory disease (PPRD). “PPRD” is a more general term that describes all respiratory disease after preterm birth without adhering to one particular definition of BPD (7).
Represented disciplines included pediatric pulmonology, neonatology, otolaryngology, sleep medicine, radiology, nursing, and families of patients. Guideline development methodology was formed using the Grading of Recommendations, Assessment, Development, and Evaluation approach (9) to rate the strength of the recommendations (Table 1). The patient/intervention/comparator/outcome format was used to formulate management questions. The panel reviewed the best available evidence in the literature. After discussion and consensus, seven recommendations were made for the outpatient management of patients with PPRD. The guideline was published in the American Journal of Respiratory and Critical
Care Medicine in 2021 (10).
This document is a summary of the clinical practice guidelines, prepared for clinicians who manage infants, children, and adolescents with PPRD in the outpatient setting. The recommendations are organized into those involving medications (Table 2) and diagnostics (Table 3). Clinicians should tailor these recommendations to individual patients’ clinical needs.
Pulmonologists, critical care specialists, translational researchers, and clinicians
At the conclusion of this activity, learners should be able to:
- Recognize when a trial of inhaled bronchodilators or inhaled corticosteroids is warranted in patients with post-prematurity respiratory disease (PPRD)
- Identify patients with PPRD and additional comorbidities who may benefit from additional diagnostic tests
- Evaluate central airway malacia in patients with PPRD and associated symptoms
The American Thoracic Society is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.
Article Authorship Disclosures (as submitted to the ATS prior to article publication date)
Laurie C. Eldredge, M.D., Ph.D. (University of Washington School of Medicine, Seattle, WA, USA) reported no relevant financial relationships.
Jonathan C. Levin, M.D. (Boston Children’s Hospital, Boston, MA, USA) reported no relevant financial relationships.
Michael C. Tracy, M.D. (Stanford University School of Medicine, Stanford, CA, USA) reported no relevant financial relationships.
Ioana A. Cristea, M.D. (Indiana University School of Medicine, Indianapolis, IA, USA) reported no relevant financial relationships.
Christopher D. Baker, M.D. (Children’s Hospital Colorado, Aurora, CO, USA) reported no relevant financial relationships.
Joseph K. Ruminjo, M.D. (American Thoracic Society, New York, NY, USA) reported no relevant financial relationships.
Carey C. Thomson, M.D., M.P.H. (Mt. Auburn Hospital, Cambridge, MA, USA) reported no relevant financial relationships.
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Disclosures of AnnalsATS CME Planners
The Annals of the American Thoracic Society (AnnalsATS) original research, commentaries, reviews, and educational content of interest to clinicians and clinical investigators in pediatric and adult pulmonary and sleep medicine and medical critical care. The scope of the journal encompasses content that is applicable to clinical practice, the formative and continuing education of clinical specialists, and the advancement of public health.
The publication of articles that meet these goals by itself is only one step in a multi-step process for the translation of evidence-based improvements in are to clinical practice. Testing for CME credit is designed to function as a next step in the process. This is accomplished through a series of questions written by the author(s) to test that readers have the tools needed to translate recommendations for diagnostic and therapeutic clinical care into clinical practice. Members of the AnnalsATS editorial board review these questions and edit these questions for clarity, educational content, and the quality of the evidence.
AnnalsATS CME Planners
Alan M. Fein, M.D.
Podcast Editor, AnnalsATS
Dr. Fein reported that he has no financial relationships with commercial interests.
Constantine Manthous, M.D.
Associate Editor, AnnalsATS
Dr. Manthous reported that he has no financial relationships with commercial interests.
Gregory A. Schmidt, M.D.
Editorial Board, AnnalsATS
Dr. Schmidt reported payments for writing a textbook on critical care medicine (McGraw-Hill) and for writing contributions for UptoDate.
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